have not the least doubt but he will be as stout as if the accident had never happened; and that, in the course of time, the muscles of the abdomen will completely recover themselves. Collingham, near Newark, Nottinghamshire, 1st Nov. 1815. } VII. On Puerperal Fever, as it appeared at Holloway, near London, in the early part of the year 1812. By DAVID DUNN, Member of the Royal College of Surgeons in London. ON N the 8th of January 1812, I was called to attend a lady in labour with her ninth child. The presentation was natural, and she was delivered within two hours after my arrival. She appeared to be doing extremely well, till the morning of the 10th, about 38 hours after delivery. When I was called to her, I found her lying on her back, labouring for breath; complaining of great pain in the abdomen, with soreness on pressure; quick pulse; moist tongue; countenance expressive of great anxiety. Never having before met with this dreadful malady, I felt at a loss what measures to pursue. However, I abstracted a few ounces of blood from the arm (which I found much difficulty in doing, the patient being extremely fat); gave her some opening medicine; and, apprizing the friends of her extreme danger, advised that no time should be lost in procuring the first assistance the town would afford. Two physicians of great eminence in the profession speedily attended. Purgatives were ordered to be continued, and the patient was again bled to the extent of ten ounces; fomentations were applied to the abdomen, and purgative enemas administered. The disease, however, continued to increase; and she died on the 13th, three days after the attack. On the 17th of February, in the same year, I attended a woman aged 25 years, who had had several children. The labour was natural, and of no long duration; she continued *very comfortable, with but trifling after-pains, and a moderate discharge, till the following evening (the 18th), when she was seized about ten o'clock (29 hours after delivery) with a severe shivering fit, accompanied with very copious bilious vomiting. This was succeeded by great heat, attended with considerable pain and soreness in the hypogastric region, and towards the left side thereof especially. I was not informed of this change till eight o'clock on the subsequent morning, when I immediately attended, and gave her Hydr. submur. gr. iij. Pilul. colocynth. cum aloe gr. xij. statim sumend. This operated briskly, and procured a plentiful discharge of foul fecal matter. On visiting her again at noon, found the pulse about 100, and small; tongue clean in the centre, white at the edges; great tenderness in the hypogastric region; pain in the head; the lower extremities cold; ordered her a saline mixture, with tartarized antimony and digitalis (fifteen drops of the latter in each dose) every four hours. 20th.-Had slept a little in the course of the night; complained of pain in the stomach and abdomen, more especially after taking anything; great tension in the stomach and hypogastrium; the lochia had ceased; pulse continued the same. Gave the digitalis in a mixture of infus. rose, with sulphate of magnesia, every four hours. 21st.-Had passed a restless night. The pain in the stomach and abdomen considerably aggravated on drinking any fluid. Pulse 120, soft, and easily yielding; the countenance flushed; head in pain; the eyes had rather a glassy appearance; the urine small in quantity, and turbid; the soreness, pain, and tension in the abdomen increased. Finding that nothing which had been done was of any avail, even in retarding the progress of the disease; though the state of the pulse rather contraindicated bleeding, and the notion I had entertained of the typhoid nature of the disease, had hitherto deterred me from having recourse to that operation; yet I now abstracted eight ounces of blood from the arm, more with a view to ascertain its nature, than as a means of relief; applied a large blister to the abdomen, and gave her half a grain of calomel with two grains of antimonial powder every four hours. In the evening her pulse was much as before; she thought the pains in the abdomen, stomach, and head, somewhat relieved. The surface of the blood was coated with a tough horny crust, about one third of an inch in thickness. I ordered her some brisk opening medicine, and repeated the bleeding. 22d. She had passed an easier night with respect to pain, but had lain in a state of low delirium. About ten o'clock this morning she was seized with most excruciating pains in the umbilical and hypogastric regions; the severity of which occasioned her to scream and roll about the bed in frantic agony; these, after lasting about an hour, ceased, and the pain subsided into its original state. She had had several stools in the course of the night. The blood was buffed as the former; but her pulse was now so much sunk as to prohibit the further detraction. Ordered a common glyster to be thrown up every three hours, and a grain of opium to be taken if the pain should return violently, and to be repeated as occasion might seem to require. Gave her also small doses of the Pulv. ipecacuanh. comp. in a saline mixture every four hours. 23d. Continued much the same; had had no severe attack of pain; urine high-coloured. In the evening she was in a state of low delirium, with subsultus tendinum. 24th.-Quite comatose; pulse 140 and very weak. A blister which had been applied the previous evening to the nape of the neck had been ineffectual. She was evidently sinking fast. I made an attempt to support her by the frequent administration of cordials and diffusible stimuli, but without effect. She died about five in the evening. Sectio Cadaveris.-The peritoneal coat of the small intestines put on a slightly reddened and inflamed appearance. The intestines were floating in an immense quantity of a serous milky fluid, in which was diffused an abundance of flaky matter of a sebaceous nature. The peritoneal investments of the stomach and large intestines assumed no unusual appearance. There was but a small portion of omentum, and that was diseased. The structure of the liver and gall-bladder was healthy, but both the latter and the stomach were gorged with green bile. The thoracic viscera perfectly natural. The fundus and body of the uterus were healthy, but the os uteri and upper part of the vagina had a dark and morbid appearance, with a looseness of texture. In two other cases, in which I had an opportunity of inspecting the bodies after death, the appearances were similar to those above described, more especially the accumulation of the serous fluid, with the sebaceous flakes, and the engorgement of the stomach and gall-bladder with green bile. Mrs G, ætat. 23 years, was, on the 29th of February 1812, delivered of a female child, at the full period of utero gestation, (it was the first). She had a safe and natural labour. She continued doing well, until Wednesday morning the 4th of March (being also the fourth day from her delivery), when she was attacked, after having passed a good night, about seven o'clock, with violent pains in the loins and abdomen, with disposition to vomit, but without shivering. She had taken part of an opening mixture, on the second day after delivery, which had cleared the bowels, and the nurse now gave a portion of what remained. About noon I was desired to visit her, and on reaching the foot of the stairs leading to her chamber, her painful and laborious breathing struck upon my ear, and instantly gave me intimation of the presence of this horrible disease. She complained of extreme pain in moving; great pain in the hypogas tric region; hot and dry skin; pulse 120, full and strong; tongue coated with a yellow fur; urine scanty and turbid; bowels constipated; great tenderness on pressing the abdomen; lochia diminished ; as also was the lacteal secretion, which had been very plentiful; tendency to delirium. I gave her the following pills. B Hydr. submuriat. gr. vj. Pilul. colocynth. cum aloe gr. xvj. M. ft. pilul. iij. statim sumend. Ordered the abdomen to be frequently fomented, and desired a physician might be called in. At five o'clock in the evening, a gentleman of great learning and deserved repute visited her with me. We found her in a state of low delirium, but, when roused, could describe her sensations. She was now bled from a large orifice, to the extent of 20 ounces, and felt considerable relief, the abdominal pain greatly subsiding, and the pulse was lessened in number and in force. She was ordered to take the following draught every four hours. B Mistur. amygdal. fl. 3iss. Liq. antimon. tartaris. m xx. M. ft. haustus. Quiet was enjoined; barley-water or toast and water for drink. At half past eight in the evening I repeated my visit. The pain, after having been considerably relieved, returned again within the last two hours. The belly was still very painful to the touch, and also when distended by inspiration. The blood which had been drawn in the afternoon was much buffed and sizy. I took away eight ounces more, and applied eight leeches to the abdomen, from which a great deal of blood was procured. Fomentations to the abdomen, and the draughts to be continued. She had this evening a very copious evacuation of fetid, dark-coloured matter from the bowels, which came away while I was taking the last blood. 5th.-At half past eight in the morning, Dr F. and myself visited her again. We found she had passed a tolerably easy night, but became worse an hour and a half before our visit. She had now a return of pain and soreness, but which had shifted from about the umbilicus to low down in the hypogastric region, and just above the pubes. Pulse about 135; skin hot; tongue white; had had some slight shiverings; tendency to sickness; great heat in the part where the pain was situated; thirst; no delirium; perfectly sensible, and capable of describing her feelings. Had passed several liquid stools in the night. B. Magnes. sulphatis 3ss. Aq. pimentæ 3iij. Syrupi 3j. Liq. antimon. tartar. mxx. M. ut ft. haustus, 4iâ quaq. horâ sds. B Hydrarg. submuriatis gr. v. Pulv. jalapæ, Pulv. rhæi, aa. gr. vj. Confect. sennæ. q. s. ut ft. pilul. iij. stat. sd. Olei olivæ 3j. Tinct. opii mxxx. M, ut ft. enema statim injiciend. As she expressed that cold was grateful to her belly, cloths dipped in the following lotion, the chill being slightly removed, were ordered to be kept applied thereto. B. Ammoniæ muriatis 3ss. To take nothing but barley-water, or toast and water. She continued lying motionless upon her back the whole of the day. In a short time after the application of the lotion, the pain almost entirely subsided. In the afternoon, she could bear me to press all over the abdomen with tolerable firmness, without much inconvenience. She could also inspire deeply, without pain; talked cheerfully, and could not be induced to obey the injunctions which had been laid upon her to forbear conversing. In the evening, on visiting her, the pulse had increased to near 150, small, and somewhat hard. I took away eight ounces more blood, which she bore exceedingly well. She had not been to stool to-day; ordered her therefore some opening pills and an enema. 6th. She had passed a very comfortable night. There was very little uneasiness upon pressure in any part of the abdomen; breathing free and easy; skin cool; tongue much as before; urine turbid. She had not had any stool, and the pulse was still as quick as yesterday. The blood last drawn, though not buffed on the surface, was, on turning it up, observed to be interlarded with patches of coagulable lymph; her health appeared to be much improved; and her friends entertained the most sanguine hopes of her recovery. From what I had before witnessed, however, and the rapid state of her pulse, I felt by no means so gratified with this delusive calm, and urged the attendance of Dr F. again. My prognostics were too true. About one o'clock in the afternoon she was seized with a shivering fit; the pain in |
